Opioids: I hope you enjoyed those sandwiches.

Howard: Probing data over a 29-month period, you and your fellow researchers found that overdose deaths are higher where opioids are most prescribed, and that they’re most prescribed where doctors are most marketed to by drug companies. How do the drug companies market to doctors?

Hadland: The most common way is to take doctors out for a meal. There’s a number of other strategies, including paying for speaker fees or honoraria, but it’s these meals that are most common. The same doctor will be taken out sometimes dozens of times.

It is legal to take doctors out for a meal, or cater for the whole office and give a dog-and-pony show, ostensibly for providing information on safe prescribing, but really to drum up sales.

The same tension exists between tests as health care and tests as profit center (CAT scans, MRI, stress tests, etc) and between “routine procedures” as health care and as profit center.

The term I like is “wallet biopsy” — the provider has, for each patient’s insurance provider, a checklist of pre-approved tests, procedures, and treatments that are associated with each combination of patient complaints and history. The alleged purpose of these is to “rule out” various complications and risks. They are coincidentally quite profitable.

The provider schedules whatever the insurance company will pay for, with the highest priority items being those with the highest markup. Improved health care is a side effect, rather than a business driver.

One reason they’re very profitable is that they’re readily scheduled. The provider much prefers to schedule available up-time of the MRI machine with regularly-scheduled tests than to make the same machine available for non-routine emergencies. “Available” means “unbilled” and “unbilled” means “not making money”.

We have an entire health-care delivery and payment system that is driven by the profit motive and that maximizes profits by maximizing utilization of expensive resources. It should not surprise us that the result is a system that produces a high volume of tests (or drugs) rather than improved outcomes.

Pro Tip: When arguing with a “free market” right winger who sees a false dichotomy of socialism/capitalism, they will often cite Stalin and the rest who have slaughtered millions of innocent people….and ask you “When has Capitalism ever killed anyone?”……..remember this as one of many times it has killed someone.